小肠间质瘤的临床特点及误诊因素

Small intestinal stromal tumors:Clinical features and factors related to misdiagnosis

目的探讨小肠间质瘤(small intestine stromal tumors,SIST)的临床特点及误诊因素.方法回顾性分析郑州大学第一附属医院2010-01/2015-01收治的104例经病理证实为S I S T患者的临床表现、病变部位、肿瘤大小、诊断方法、危险度分级等临床资料.结果临床常见症状主要包括腹部包块6 7例(64.5%)、消化道出血47例(52.8%)、腹痛47例(52.8%).病变部位以空肠多见,占45.2%,其次是回肠(29.8%)、十二指肠(25.0%).本研究中该病误诊率高达34.6%,极易误诊为妇科肿瘤(15/36)、消化系平滑肌瘤(6/36)等疾病,其误诊与临床表现、肿瘤部位、肿瘤大小、生长方式、检查方法等因素有关.结论S I S T是多发于空肠且以腹部包块、消化道出血等为常见临床表现的胃肠道间质瘤,其临床误诊率较高,故对于彩超、CT及消化内镜不能明确诊断的反复消化道出血、腹部包块患者及时行手术活检及免疫组化等检查,以便早期诊断,避免误诊.

AIM To analyze the clinical characteristics of smallintestinal stromal tumors（SISTs） and identify factors related to their misdiagnosis.METHODS Clinical data of 104 patients with pathologically proved SISTs were retrospectively analyzed at our hospital from January 2010 to January 2015,with regard to clinical features,tumor location,tumor size,diagnostic methods,and risk classification.RESULTS Common clinical symptoms included abdominal mass（67/104,64.5%）,gastrointestinal bleeding（47/104,52.8%）,and abdominal pain（47/104,52.8%）.The lesions were seen mainly in the jejunum（45.2%）,followed by the ileum（29.8%） and duodenum（25%）.The misdiagnosis rate was as high as 34.6%,and SISTs were often misdiagnosed as gynecological tumors（15/36）,digestive tract leiomyomas（6/36） and other diseases.The misdiagnosis was related,to a certain extent,to clinical manifestations,tumor location,tumor size,growth mode,examination methods and other factors,but had nothing to do with sex,age of onset,risk classification,or metastasis.CONCLUSION SISTs frequently occur in the jejunum,with gastrointestinal bleeding and abdominal mass being common clinical manifestations.Its clinical misdiagnosis rate is high.Therefore,for patients with recurrent gastrointestinal bleeding and abdominal mass that cannot be clearly diagnosed by color Doppler ultrasound,CT and digestive endoscopy,timely surgical biopsy and immunohistochemistry examination should beperformed to achieve early diagnosis and avoid misdiagnosis.